Mediastinitis In Patients Research Articles

Poorly controlled diabetes mellitus is strongly associated with descending necrotizing mediastinitis of odontogenic origin

We hypothesized that poorly controlled diabetic status may be a negative prognostic factor for acute mediastinitis of odontogenic origin, and we conducted a cohort study to verify this hypothesis. Data were collected on all consecutive patients diagnosed with maxillofacial infections of odontogenic origin who received surgical treatment in the Oral and Maxillofacial Surgery Department. All patients included in the study were divided into 4 groups based on the presence or absence of diabetes and mediastinitis. Poorly controlled diabetic status constituted our primary predictor variable, and the occurrence of descending necrotizing mediastinitis was the outcome variable. All 7 patients with poorly controlled diabetes mellitus were complicated with descending necrotizing mediastinitis. An exact Fischer test was conducted to investigate the association of poorly controlled diabetes mellitus with descending necrotizing mediastinitis in patients admitted for surgical treatment of their maxillofacial collection. The result was significant at P < .01. This study represents the first scientific attempt to associate poorly controlled diabetes mellitus with descending necrotizing mediastinitis of odontogenic origin. Our results show evidently that these patients are more susceptible to deep space infections, which subsequently spread faster and are much more difficult to control.

Risk factors to develop mediastinitis in patients with deep neck abscess

Risk factors to develop mediastinitis in patients with deep neck abscess

Necrotizing Mediastinitis Following Dental Extraction: A Case Report.

IntroductionNecrotizing mediastinitis is a rare complication following a dental procedure. It is frequently lethal and requires prompt diagnosis with advanced imaging, administration of broad-spectrum antimicrobials, and early surgical consultation.Case ReportA 19-year-old, otherwise healthy male presented to the emergency department with chest pain, muffled voice, and facial and neck swelling six days following dental extraction. He was found to have a retropharyngeal abscess causing necrotizing mediastinitis and septic shock. The patient was started on broad-spectrum antimicrobials, required 10 surgical procedures, and experienced a prolonged hospitalization.ConclusionConsider necrotizing mediastinitis in patients presenting with chest pain and signs of retropharyngeal infection after dental procedures. Prompt imaging, antimicrobial therapy, and surgical consultation is critical in treating this frequently fatal disease.

ETIOLOGICAL STRUCTURE OF MICROBIOTA IN ODONTOGENIC INFECTIOUS INFLAMMATORY DISEASES OF MAXILLOFACIAL AREA

In recent decades, the etiological structure of infectious complications in surgery has remained almost unchanged. The aim of this study is to identify the leading pathogens of odontogenic infectious and inflammatory diseases of the maxillofacial area in patients. Materials and methods. The study involved 137 patients with odontogenic infectious and inflammatory diseases of the maxillofacial area. The final species identification of microorganisms was performed according to the generally accepted method. Results. 117 clinical strains of microorganisms were isolated from patients and identified. It was found the most common causative agents of odontogenic infectious and inflammatory diseases of the maxillofacial area in patients were gram-positive cocci. It should be noted that the vast majority of isolates were members of the genus Staphylococcus. Gram-negative microorganisms were detected in patients much less frequently (31.6%) compared with gram-positive. In 5.1% of case, C. albicans acted as the dominant pathogen in the material taken from patients with purulent diseases. It was found out that during the development of the abscess, the microbiota were more diverse, but the percentage of pathogens differed significantly with the selection of S. aureus, A. baumannii and E. faecalis as the main ones. In turn, with the aggravation of the infectious process and the development of phlegmon and mediastinitis in patients, a decrease in the spectrum of microorganisms in the studied materials was observed, along with an increase in their percentages. Conclusions. The etiological structure of microbiota of odontogenic infectious-inflammatory diseases of the maxillofacial area is predominantly represented by opportunistic microorganisms of the genera Staphylococcus, Enterococcus, Acinetobacter and Pseudomonas. In general, gram-positive cocci and non-fermenting gram-negative bacteria are the dominant causative agents of odontogenic infectious-inflammatory diseases of the maxillofacial area in most surgical patients.

Risk factors for mediastinitis in the post-operative period of heart surgery

Objectives: The study’s main purpose has been to identify both pre and postoperative risk factors related to the development of mediastinitis among patients who underwent cardiac surgery at a hospital from the Rio de Janeiro city. Furthermore, to characterize the study population and to analyze the relationship between risk factors and the incidence of mediastinitis in patients who underwent cardiac surgery. Methods: It is a descriptive and retrospective study with a quantitative approach, where there were identified the risk factors related to the development of mediastinitis in patients who underwent cardiac surgery at a university hospital from the Rio de Janeiro State. Results: There were obtained a total of 192 patients, mostly males, within the age group from 50 to 69 years old and overweight. Diabetes mellitus and smoking were the most frequent comorbidities, and coronary artery bypass graft surgery was the most performed surgery, 4 patients had mediastinitis. Conclusion: The identification of such factors contributes to the elaboration of prevention strategies for mediastinitis, and the implementation of nursing care in both pre and postoperative periods of cardiac surgeries.

Evaluation of post-operative development of mediastinitis in patients undergoing isolated coronary artery bypass grafting surgery: A single-center experience.

In this study, we aimed to evaluate mediastinitis cases developed after isolated coronary artery bypass graft surgery performed by median sternotomy to determine the causative microorganisms, risk factors, and clinical features. Between March 2009 and December 2018, a total of 44 patients (32 males and 12 females; mean age 62.84±6.951 years; range, 46-78 years) who underwent isolated coronary artery bypass grafting surgery with median sternotomy and developed mediastinitis postoperatively were included in the studying our cardiovascular surgery (CVS) department. Patients demographic information, comorbidities, habits, pre-operative hospital stay, elective or emergency surgery, perioperative internal mammary artery use, perioperative blood or blood product, operation and cardiopulmonary bypass times, suitability of antibiotic prophylaxis, medical and surgical treatment, clinical data, and laboratory results were retrospectively analyzed. Purulent discharge cultures obtained directly from the mediastinal space and microbiological examination notes made from the material obtained from the surgical site or surgical repair were recorded. In isolated coronary artery bypass grafting surgery performed over a period of approximately 10 years, the rate of mediastinitis was 1%. There was no statistically significant difference between patients with and without mediastinitis in terms of age, sex, smoking habits, duration of operation and cardiopulmonary bypass, and intraoperative blood transfusion. The presence of diabetes mellitus and high mean body mass index was significantly higher in patients with mediastinitis compared to those without. Mediastinitis was diagnosed in 38 (86.3%) patients in the 1st month, 5 (11.3%) in the first 3 months, and 1 (2.2%) in the 1st year. Twenty-five (56.9%) Gram-positive bacteria, 13 (29.6%) Gram-negative bacteria, and 1 (2.3%) fungi were the microorganisms grown in purulent discharge cultures. Pathogen microorganisms could not be produced in 5 (11.4%) cases. The three most commonly isolated agents were methicillin-resistant coagulase-negative staphylococci (MRCNS) (50%), Escherichia coli (9.1%), and Klebsiella pneumoniae (6.8%). Attention should be paid to surgical site infection in patients undergoing CVS. Following discharge, follow-up is important and empirical treatment should be determined by considering the presence of MRCNS as the leading infectious agent in our hospital when infection occurs.

Early Outcome of Coronary Artery Bypass Graft Surgery in Patients with Preoperative Elevated Level of HbA1c with Diabetes Mellitus

Introduction: Diabetes mellitus has been associated with an increased risk of adverse outcome after coronary artery bypass graft surgery. HbA1c is a reliable measure of long-term glucose control. It is unknown whether adequacy of diabetic control, measured by hemoglobin A1c, is a predictor of adverse outcomes after coronary artery bypass grafting. The predictive role of HbA1c on short term outcomes after coronary artery bypass graft surgery has not been evaluated. Diabetes mellitus has become a major health issue and contributes to morbidity and mortality from coronary artery disease. The purpose of this study is to determine the predictive role of preoperative elevated HbA1c on post-operative outcome in CABG patients.&#x0D; Objectives: This study evaluates the early postoperative outcomes of CABG in terms of mortality and major postoperative morbidities like deep sternal wound infection, sepsis, stroke, renal failure, bleeding, arrhythmia, and mediastinitis in patients with preoperative elevated level of HbA1c. Methods: This prospective study was done in National Institute of Cardiovascular Diseases (NICVD). Patients of coronary artery disease (CAD) with DM referred for CABG were enrolled for the study. Total 60 patients were allocated into two groups. Among them 30 patients with preoperative HbA1c of &lt;7% and another 30 patients with preoperative HbA1c of &gt; 7 % underwent CABG surgery from January, 2009 to December, 2010. The early postoperative outcomes were compared between two groups. Both groups were matched with no significant difference that could influence the postoperative outcome.&#x0D; Results: In-hospital mortality was high in patients with preoperative elevated level of HbA1c. An elevated hemoglobin A1c level predicted in-hospital mortality after CABG surgery. Our study revealed that HbA1c greater than 7 % was associated with increase in mortality. For each unit increase hemoglobin A1c , there was a significantly increase risk of myocardial infarction and deep sternal wound infection. By using receiver operating characteristic value thresholds, renal failure, cerebrovascular accident and deep sternal wound infection occurred more commonly in patients with elevated hemoglobin A1c. Morbidity, infections and the composite outcomes occurred more commonly in patients with elevated HbA1c.&#x0D; Conclusion: Elevated HbA1c is strongly associated with adverse events after coronary artery bypass graft surgery. Preoperative HbA1c measurement may allow for more accurate risk stratification in patients undergoing coronary artery bypass graft surgery.&#x0D; Bangladesh Heart Journal 2019; 34(2) : 92-99

Clinical-care protocol for preventing mediastinitis after coronary artery bypass graft surgery: A quality improvement initiative from a private hospital.

Surgical site infections after cardiac surgery are associated with severe outcomes, including reoperation and death. We aimed to describe the effect of a standardized clinical-care protocol for preventing mediastinitis in patients who underwent coronary artery bypass graft surgery (CABG). In a hospital certified by Joint Commission International, all patients who underwent CABG from January 2011 to December 2016 were compared in two periods according to the moment of implementation of a standardized clinical-care protocol for prevention of mediastinitis (CCPPM): pre-protocol (January 2011-December 2012) and post-protocol (January 2013-December 2016). The CCPPM consisted of the patient using a kit containing chlorhexidine 2% for bathing, mupirocin 20 mg/g for nasal topical use and chlorhexidine 0.12% for oral hygiene for 5 days before surgery, in addition to prophylaxis with a glycopeptide antimicrobial and strict glucose control (110-140 mg/dL) during surgery and immediate postoperative. We evaluated 1760 patients who underwent CABG in both periods. The occurrence of mediastinitis before protocol implementation was 1.44% (10 of 692 CABG). After the implementation of the protocol, there was an important reduction in the incidence of mediastinitis to 0.09% (1 of 1068 CABG) (P = 0.002). Although we did not observe a significant difference in mortality between the groups (2.3% vs 1%, P = 0.77), there was fewer in-hospital mortality due to mediastinitis after the CCPPM (0.2% vs 0%, P < 0.001). Implementation of a standardized CCPPM was associated with a significant reduction in the incidence of mediastinitis after CABG and reduction of mortality in the group of patients with mediastinitis.

Mediastinite após cirurgias valvares cardíacas: revisão integrativa

A mediastinite é uma infecção do tecido conjuntivo do mediastino, pouco estudada em pacientes submetidos às cirurgias de correção de valvopatias cardíacas. O objetivo deste estudo foiidentificar na literatura as evidências relacionadas à mediastinite em pacientes submetidos às cirurgias para correção de valvopatias cardíacas. Foi realizado uma revisão integrativa com buscas, em cinco bases de dados eletrônicas: LILACS, PubMed, Scopus, EBSCOhoste Web of Science. De acordo com os critérios estabelecidos, quatro artigos foram incluídos para a análise e mostraram aspectos sobre a mediastinite, como: preditores de mortalidade no pré-operatório, contaminação de materiais no intraoperatório e técnica de abordagem cirúrgica. Estudos com enfoque específico à ocorrência de mediastinite nestes pacientes, podem instrumentalizar a equipe de saúde e melhorar a implementação das ações na prática clínica, prevenindo complicações.

Descending necrotizing mediastinitis in patients with neck phlegmons

Objective: to study the results of treatment in patients with descending necrotizing mediastinitis, depending on the etiology and spread of suppuration. Materials and methods. 137 patients with deep neck phlegmons have been included. Descending necrotizing media­stinitis was diagnosed in 67 (48.9 %) of them. Results. In most cases, suppuration in the mediastinum arose from odontogenic neck phlegmons (34 patients, or 50.8 %). In 17 (25.4 %) cases of perforation of cervical esophagus and hypopharynx, pus extended downward into the posterior mediastinum. Paratonsillar and retropharyngeal abscesses were complicated by descending necrotizing mediastinitis in 13 (19.4 %) patients, and in 10 cases pus spread into the posterior mediastinum. In 56 (82 %) of the 67 observations, mediastinitis limited to the upper parts, and it was the same lesion of anterior-upper (27 persons, or 40.3 %) and posterior-upper (28, or 41.7 %) mediastinum. Spread to the inferior mediastinum was found in 7 (10.5 %) patients. Synchronous suppuration in the anterior-upper and posterior-upper parts of mediastinum was observed in 5 (7.5 %) cases. Surgical debridement of deep neck phlegmons has been always finished with the revision of the mediastinum through cervicomediastinotomy. During the surgery, a target search for directions of pus spread was performed according to their origin. Conclusions. Among the descending necrotizing mediastinitis, odontogenic neck phlegmons are the most common — a half of the cases (34 patients, or 50.8 %). Perforations of cervical esophagus are observed in 25.4 % of cases of descending necrotizing mediastinitis, and paratonsillar abscesses — in 19.4 %. Incision and drainage of deep neck phlegmons would always include a target revision of suppurations in the mediastinum, depending on their origin.

Predictors of Mediastinitis Risk after Coronary Artery Bypass Surgery: Applicability of Score in 1.322 Cases.

BackgroundMediastinitis is a severe surgical complication of low incidence, but high lethality. Scores used in the preoperative period to stratify the risk of postoperative mediastinitis may contribute to improve the results.ObjectiveTo test the applicability of the MagedanzSCORE in predicting the risk factors for mediastinitis in patients undergoing coronary artery bypass grafting at a cardiology reference hospital.MethodsHistorical cohort study with adult patients who underwent coronary artery bypass grafting. The analyzed variables were contemplated in the MagedanzSCORE: reoperation, chronic obstructive pulmonary disease (COPD), obesity, class IV unstable angina, polytransfusion therapy, mediastinitis and death as outcome variables.ResultsOf the 1.322 patients examined, 56 (4.2%) developed mediastinitis. Of these, 26 (46.4%) were classified as high risk for mediastinitis and 15 (26.8%) at very high risk for mediastinitis. Three of the five variables of the Magendanz Score showed statistically significant differences: reoperation, COPD and obesity. Class IV unstable angina and postoperative polytransfusion were not associated with mediastinitis after coronary artery by-pass grafting. The area under the ROC curve was 0.80 (CI 95% 0.73 - 0.86), indicating the model's satisfactory ability to predict the occurrence of mediastinitis.ConclusionThe tool was useful in the preoperative assessment demonstrating the risk for mediastinitis in this population of intensive care patients.

The effect of Clostridium difficile infection on cardiac surgery outcomes.

Clostridium difficile (CD) is a common cause of healthcare-associated infectious colitis that complicates about 1% of all hospital stays in the U.S. The impact of CD on outcomes after coronary artery bypass grafting (CABG) and valvular surgery (VS) is not well known. The Nationwide Inpatient Sample (2002-2009) was queried to identify CABG and VS patients utilizing International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnosis codes. Rates of CD, post-operative endocarditis and mediastinitis, hospital mortality rate, and resource utilization were evaluated. We identified 421,294 and 90,923 patients of age 40 yrs and older who underwent CABG and VS, respectively. The CD infection was more likely to develop in patients undergoing VS than in those having CABG (odds ratio [OR] 1.8; 95% confidence interval [CI] 1.64-1.92) and was more likely after urgent or emergency admission than after elective admission (OR 1.8; 95% CI 1.68-1.94). There was a greater likelihood of mediastinitis in patients with CD after CABG than in non-complicated cases without CD, both by univariable (OR 6.0; 95% CI 3.07-11.62) and multivariable analysis with adjustment for patient age, gender, race, type of admission, and co-morbidities (OR 3.1; 95% CI 1.49-6.51). The infection thus was most likely a result of the antibiotics used to treat mediastinitis, as the patients treated for mediastinitis were most likely to develop CD. There was a significant association in patients with CD and endocarditis who underwent VS but not in patients who did not have CD. The CD infection in these patients thus was most likely a result of the antibiotics used to treat endocarditis. Endocarditis and CD developed 3.2 times (95% CI 2.65-3.97) as often as in patients without CD, a finding that was confirmed by multivariable analysis (OR 2.2; 95% CI 1.70-2.84). At the same time, in patients having VS, there was no significant association of CD and mediastinitis. Clostridium difficile infection affected the hospital mortality rate significantly after both CABG (OR 2.0; 95% CI 1.65-2.35) and VS (OR 1.9; 95% CI 1.51-2.39). Development of CD increased median hospital length of stay and cost dramatically after both CABG (from 7 d to 19 d and from $33,105 to $65,535, respectively; p<0.0001 for both) and VS (from 8 d to 24 d and from $41,876 to $95,699, respectively; p<0.0001 for both). The development of CD worsened significantly the outcomes of adult patients undergoing cardiac surgery. There was a greater risk of CD in patients with either mediastinitis or endocarditis. The infection was associated with a higher hospital mortality rate, longer hospital stays, and greater cost after both CABG and VS.

Risk factors and incidence of mediastinitis in patients with lung abscess and sepsis

Mediastinitis is a life-threatening condition, which is accompanied by high rates of mortality in cases of delayed diagnosis and inadequate treatment. The aim of the study was to identify the risk factors and incidence of mediastinitis in patients with lung abscess and sepsis.

Is There a Role for Robotic Totally Endoscopic Coronary Artery Bypass in Patients With a Colostomy?

Preoperative colostomy presents a significant risk of sternal wound complications, mediastinitis, and ostomy injury in patients requiring coronary artery bypass grafting. Less invasive procedures in coronary surgery have a potential to reduce the risk of sternal wound healing problems. Robotic totally endoscopic coronary artery bypass grafting in patients with a colostomy has not been reported. We describe a case of completely endoscopic coronary surgery using the da Vinci Si system in a patient with a transverse colostomy. Single left internal mammary artery grafting to the left anterior coronary artery was performed successfully on the beating heart. We regard this technique as the least invasive method of surgical coronary revascularization with a potential to reduce the risk of surgical site infection and mediastinitis in patients with a colostomy.

Deep neck infections: risk factors for mediastinal extension

The goal of the study was to find out the risk factors for the development of mediastinitis in patients with deep neck infections (DNI) and describe the differences in symptoms and clinical image between uncomplicated DNI and infections with mediastinal spread. Our study represents the retrospective analysis of 634 patients with DNI. The file was divided into two groups. There were 619 patients (97.6%) in the first group who had an uncomplicated course of DNI without spread of infection into mediastinum (DNI group). The second group included 15 patients (2.4%) with descending mediastinitis as a complication of DNI (mediastinitis group). The most frequent comorbidities were cardiac and pulmonary diseases, which were more frequent in the mediastinitis group comparing to DNI group. Dental origin of the infection was more frequent in DNI group than in the mediastinitis group. On the other hand, tonsillar origin of the infection was more frequent in the mediastinitis group than in DNI group. In both mediastinitis and DNI groups, the typical presenting symptoms were pain, oedema and dysphagia. Furthermore, dysphagia, dyspnoea, dysphonia and restriction of neck movements were more significant in the mediastinitis group than in DNI group. The incidence of airway obstruction, sepsis, pneumonia and death was significantly higher in the mediastinitis group than in DNI group. Due to our results, the predisposing factors for mediastinal extension of DNI are cardiovascular and pulmonary diseases. Mediastinitis is associated with higher morbidity and mortality than DNI. The most common complications are airway obstruction, pneumonia and sepsis.

Estudio de casos y controles de los factores de riesgo de mediastinitis en cirugía de revascularización miocárdica

Introduction and objectivesMediastinitis is a complication of coronary artery bypass graft surgery (CABG) causing high morbidity and mortality. The aim of this study was to identify risk factors for suffering from mediastinitis in patients undergoing CABG with or without additional cardiac surgery, and the microorganisms involved in this infection. MethodA retrospective case-control study was conducted on patients who underwent a CABG during the years 2004-2008 in a third level hospital. The cases were all patients with postoperative mediastinitis. Two controls of similar age were randomly selected for each case. The study variables were collected by reviewing medical records, and univariate and multivariate analyses were performed on these. ResultsThere were 73 mediastinitis in a total of 1353 surgeries (incidence: 5.39%). In the logistic regression model, the risk factors for acquiring mediastinitis were: greater than or equal to grade II obesity (p=004), surgeon (p=004), renal failure (p=006), postoperative ICU stay exceeding 3 days (p=019), and additional cardiac surgery (p=020). The microorganisms most commonly isolated were staphylococci, and mostly S epidermidis (30.7%). ConclusionsThe surgeon, obesity, renal failure, associated valvular surgery procedure, and postoperative ICU stay exceeding 3 days, are the risk factors associated with mediastinitis in patients undergoing CABG.

Acute Mediastinitis Due to Extravasation of Parenteral Nutritional Formula via a Central Venous Catheter

Mediastinitis is a complication generally associated with thoracic surgery. Its occurrence after placement of a central venous catheter is uncommon, and only a few cases have been reported. An 83-year-old man who had mediastinitis due to extravasation of parenteral nutritional formula via a central venous catheter is presented. The signs and symptoms, diagnosis, and treatment of this unusual complication are described. This complication should be included in the differential diagnosis of mediastinitis in patients with a central venous catheter in place who have not had thoracic surgery.

Clinical outcomes of open heart surgery in patients with atopic dermatitis

Atopic dermatitis is a skin condition often complicated by colonization with Staphylococcus aureus, which increases the risk of infective endocarditis, skin cellulitis and osteomyelitis. Positive cultures for Staphylococcus aureus are obtained from 70% to 80% of wounds in patients with mediastinitis. Thus sternotomy carries increased risk of mediastinitis in patients with atopic dermatitis. We retrospectively reviewed 25 patients with atopic dermatitis who underwent cardiac surgery via a median sternotomy or thoracotomy from January 1997 to September 2010 at our institution. Postoperative mediastinitis due to methicillin-resistant Staphylococcus aureus was found in 3 patients who had a median sternotomy. They were ultimately discharged in good condition. No mediastinitis occurred in patients undergoing thoracotomy. Mediastinitis may occur due to direct exposure of the bone marrow to methicillin-resistant Staphylococcus aureus in patients with atopic dermatitis whose skin is colonized with such bacteria. Thoracotomy may be a better surgical approach in patients with atopic dermatitis who require thoracic surgery.

Antibiotic prophylaxis and incidence of endocarditis and mediastinitis in patients undergoing cardiac surgery

BackgroundMediastinitis and endocarditis after cardiac surgery are serious complications that increase short and long term morbidity and mortality and also costs. Antibiotic prophylaxis aims to reduce the risk of surgical...

Acute kidney injury following coronary artery bypass grafting: early mortality and postoperative complications

Objectives. To investigate the prognostic importance of acute kidney injury on early mortality, postoperative stroke, and mediastinitis in patients undergoing a first isolated coronary artery bypass grafting. Design. 7594 patients undergoing coronary artery bypass grafting with information on pre- and postoperative serum-creatinine values were included. Patients were classified using the Acute Kidney Injury Network classification. Odds ratios (OR) for mortality and postoperative complications within 60 days of surgery were calculated after adjustment for confounders separately for stage 1 and for stages 2 and 3 together. Results. 1047 (14%) patients developed acute kidney injury. There were 132 (1.7%) deaths, 103 (1.4%) strokes and 118 (1.6%) cases of mediastinitis during follow-up. Among patients in stage 1 the adjusted odds ratio for death was 4.36 (95% confidence interval 2.83–6.71) and for stage 2 plus 3; 21.5 (12.0–38.6) compared to patients without acute kidney injury. Corresponding OR for stroke were 2.34 (1.43–3.82) and 6.52 (2.97–14.3) and for mediastinitis 2.88 (1.84–4.50) and 4.68 (2.07–10.6), respectively. Conclusions. Acute kidney injury following coronary artery bypass grafting is related to postoperative mortality, stroke, and mediastinitis. Patients undergoing coronary artery bypass grafting should be assessed for presence of acute kidney injury postoperatively, in order to predict early prognosis.